Modern medicine is constantly improving the methods of combating glaucoma, an eye disease caused by increased intraocular pressure; the medications themselves are changing, and new methods of diagnostics and treatment are emerging. But the problem of the availability of medicines, including for low-income patients, has not yet been solved.

Combating glaucoma

Glaucoma is one of the most common chronic eye diseases: it affects 3% of the world’s population. In Russia, according to the Federal Research Institute for Health Organization and Informatics of the Ministry of Health, there were 1.3 million glaucoma patients in 2020. The number of newly diagnosed cases increases by 3-4 % every year. Glaucoma accounts for 20 % of all eye pathology. The incidence of glaucoma in Russia is 910 per 100,000 people. Since 2013, the number of cases detected per year has increased by more than 10%.

In general, the situation with the treatment of glaucoma demonstrates a positive trend. Improved effectiveness of occupational health examinations and dispensary follow-up, the introduction of high-tech methods of diagnosis and treatment throughout the country, updated clinical recommendations and other measures reduced the disability rate related to this disease from 41.2% in 2013 to 27 % in 2019.  The diagnostics now involves new methods, including AI-based approaches. Thanks to AI, the accuracy of diagnostics has reached the level which seemed unattainable before. If a human diagnoses glaucoma with an accuracy of up to 55 %, the neural network provides an accuracy of up to 93 %.

There is a wide range of drugs for the treatment of glaucoma on the international market, these products are also available in Russia.    According to experts interviewed by GxP News, in the last two or three years, the Russian market has become very diversified. New companies have appeared, and players who have been working in this field for a long time have opened new ophthalmological product lines. Ophthalmologists have a wide range of drugs in their arsenal.

Screenings and therapy

The problem is that many of these modern tools are now inaffordable to the majority of people with glaucoma, including low-income patients. “As far as the presence of drugs on the market is concerned, we have everything that our foreign colleagues have. But the affordability is different: there are not enough funds allocated by the state, and not only in regional budgets, but even in Moscow, for example,” Alexander Kuroedov, the head of the ophthalmological department of the P. V. Mandryk Central Military Clinical Hospital, says.

According to representatives of pharmaceutical companies, the list of medicines for preferential categories of patients usually includes the most affordable medicines rather than the most modern ones. “Timolol has traditionally had a significant market share in the treatment of glaucoma. The argument here is the price. However, there are a number of more modern drugs, and the global trend is that ophthalmologists now tend to prescribe not mono-preparations but combinations of molecules. We are also following the global trend, and the share of Timolol is going down, but this is happening slowly,”  one of the GxP News interlocutors notes.

Anzhella Fursova, the chief ophthalmologist of the Novosibirsk region, believes that, as the treatment of glaucoma with local hypotensive therapy is lifelong, it should be fully funded by the state. She is sure that only in this case is it possible to ensure that patients comply with the treatment regimen and control the course of the disease.

Another organizational gap, according to Alexander Kuroedov from the P. V. Mandryk Central Military Clinical Hospital, is the absence of the appropriate screening programs for the detection of glaucoma. “It is necessary to collect more detailed statistics of patients with a predisposition to sight-threatening diseases.  For a long time, the level of intraocular pressure was checked only in patients aged 40 and older (the order of the Ministry of Health of the USSR No. 925 of 22.09.1976 “On reinforcing measures for early detection and active monitoring of glaucoma patients”),  a new order was recently prepared by the Ministry of Health of the Russian Federation, according to which intraocular pressure will be measured in younger patients, but we should not stop there,” he says.

When examining patients of risk groups (with a family history of glaucoma), it is necessary to use questionnaires and conduct a standard examination of the patient. If the diagnosis is established, the patient must be followed up regularly by an ophthalmologist,” Anzhella Fursova notes.

Patient education

The cornerstone in the fight against glaucoma is the attitude of patients themselves to the diagnostics and treatment of this disease, as they are not always willing to participate in diagnostics, do not demonstrate sufficient commitment to therapy, violate the recommendations of ophthalmologists, do not want to switch to more modern treatment regimens.

Patients with glaucoma are, as a rule, elderly people who need to be taught how to administer eye drops properly, how to use a bottle, and they should not be afraid to do it. Another issue is the transition to a more modern therapy. It often happens that in patients who have been using, for example, timolol, the cheapest drug which is easily available to them, the receptors have already lost sensitivity, and another molecule with a more powerful effect is needed. But patient continue to buy the drug that they are used to. Unfortunately, a doctor has only 12 minutes for an appointment, and there is no time to give the necessary explanations.

According to experts interviewed by GxP News, only state support and the organization of schools for patients with ophthalmological diseases, following the example of diabetes schools, can provide a systemic solution to the problem. In their opinion, the state has to provide a systematic solution of the problem, both in financial and organizational terms. Conditions have to be created in which the doctor will have time for a conversation with their patients, an opportunity to pay attention to them, meet them to explain the specifics of the treatment, sometimes more than once. All these are very important steps that can radically improve the quality and effectiveness of glaucoma therapy.